Shock

1. -: PRESENTED BY :-
ASSISTANT PROF. NATHANI ZEESHAN
MUNAF
DEPT. OF PHARMACOLOGY
SHOCK
PROF. RAVINDRA NIKAM COLLEGE OF PHARMACY
Morane – Gondur By-Pass Road, Near Punam Petrol Pump,
Gondur, Tal. dist. Dhule- 424001
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2. SHOCK
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3. CONTENTS
 SHOCK
 DIFFERENT TYPES OF SHOCK
 PATHOPHYSIOLOGY
 SIGN AND SYMPTOMS OF SHOCK
 DRUG THERAPY OF SHOCK
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4.  Shock is a state in which there is
inadequate blood flow to the tissues to
meet demand.
 Shock and hypotension often co-exist, BUT
a normal blood pressure DOES NOT
exclude the diagnosis of shock.
 There is a lack of blood flow that cause
the organ to failure.
SHOCK
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5. Different types of Shock:
1.Hypovolemic
2.Cardiogenic
3.Distributive
4.Obstructive 10/7/2020Z.M.NATHANI 5

6. 1. Hypovolemic shock due to inadequate
circulating fluid volume
Causes:
 Divided to hemorrhagic or non-
hemorrhagic
 major burns; gastrointestinal losses:
vomiting, fistulas, urinary losses: diabetes,
diabetes insipid us; evaporative losses with
fever, abdominal surgery
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7. 2. Cardiogenic shock due to cardiac pump
failure resulting from myocardial or valvular
failure
Causes:
 Acute coronary syndrome in this ICU with
CTS specialty we also encounter post-
cardiotomy syndrome
 Other causes: arrhythmia, myocardial
contusions post-trauma; myocarditis: acute
valvular dysfunction: cardiomyopathy echo is
very useful in reviewing the cause and
monitor 10/7/2020Z.M.NATHANI 7

8. 3. Distributive shock due to peripheral vascular
dilation causes a fall in peripheral resistance.
Causes
Septic shock
 Anaphylaxis shock
 Neurogenic shock
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9. 4. Obstructive shock due to obstruction of
great vessels or heart that implies the blood
flow.
Causes
Cardiac pneumothorax
Pulmonary embolism
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10. Pathophysiology
Step – 1 there is a trigger that decreases
blood flow to the organ
Step - 2 compensatory mechanism kick in
Step - 3 metabolic acidosis
Step - 4 organ failure
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11. SIGN AND SYMPTOMS OF SHOCK
 Increased heart rate
 Increased respiratory rate
 Decreased blood pressure
 Thready pulse
 Decreased peripheral pulses
 Cyanosis
 Neurological symptoms
 Decreased urine output
 Absent bowel sound
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12. Drug Therapy Of Shock
1.Sympathomimetic amines
2.Alpha-adrenoreceptor blocking agents
3.Corticosteroids
4.Oxygen
5.Cardiac glycosides
6.Glucagone
7.Dextrans
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13. 1.Sympathomimetic amines
lone trope : an agent that changes myocardial
contractility.
Vasopressor: an agent that increases
blood pressure
Chronotrope : an agent that changes heart rate
Dromotrope : an agent that increases
cardiac conduction velocity.
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14. NOREPINEPHRINE
Most widely used vasopressor Potent at agonist
causing vasoconstriction in tissue beds. Resultant
increase in SVR causes rise in blood pressure.
Standard dose : 4 mg in 50 ml (0.08 mg/ml)
EPINEPHRINE
Nature's vasopressor most commonly used
during resuscitation cardiac arrest and
anaphylaxis.
Alpha1: increases SVR
Beta1: increases HR and myocardial contractility.
Beta2: bronchial smooth muscle relaxation
Standard dose : 10 min 0.2mg/ml) 10/7/2020Z.M.NATHANI 14

15. DOPAMINE
It is a vasopressor agent.
It is use in cardiogenic & septic shock.
Receptor stimulation depend on dose given
Low dose :Beta1-renal perfusion
Medium dose :Beta1-CO
High dose: Alpha1 vasoconstriction, PVR
Standard dose : 0.2-1 mg/min
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16. DOBUTAMINE
A synthetic catecholamine.
Beta1stimulation: increase HR and increase
cardiac contractility.
Beta 2 mediated vasodilatation.
Reduction in MAP is common with dobutamine.
NE usually needed to offset vasodilatation,
Standard dose : 250mg in 50 ml(5mg/ml)
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17. 2.Alpha-adrenoreceptorblocking agents
1. Pentolamine
2. Phenoxybenzamine
Advantages
1. The harmful effect of vasoconstriction on
microcirculation in tissues is avoided.
2. They permit rapid administration of
intravenous fluid without increasing central
venous pressure.
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18. Glucocorticoids
(Adrenal Cortex Hormones That Control Glucose
Metabolism).
Glucocorticoids are frequently given to patients
in severe shock for several
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19. Reasons:
(1) increase the strength of the heart in the
late stages of shock;
(2) glucocorticoids stabilize lysosomes in
tissue cells and thereby prevent release of
lysosome enzymes into the cytoplasm of
the cells, thus preventing deterioration from
this source; and
(3) glucocorticoids might aid in the
metabolism of glucose by their damaged
sells
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20. Oxygen Therapy.
major effect of shock is too little
delivery of oxygen to the tissues, giving
the patient oxygen to breathe can be of
benefit in many instances.
However, this frequently is far less
beneficial than one might expect,
because the problem in most
types of shock is not inadequate
oxygenation of the blood by the lungs
but inadequate transport of the blood
after it is oxygenated.
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21. CARDIAC GLYCOSIDES
Increases the myocardial contractility and raises
the cardiac output
Dose - 1-2mg IV.
Side effect - Nausea, vomiting and cardiac
arrhythmias
Increases the myocardial contractility Given in
reduced doses slowly to avoid
peripheral vasoconstrictive action.
GLUCAGON
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22. DEXTRANS
1. It reduces the viscosity of blood by
inducing a negative charge on the RBCs causing
them to repel each other.
2. Improves microcirculation.
1. Vasodilator drugs
2. Diuretics
3. Alkalizing agents
4. Heparin
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